--- title: "Part V, Subpart iii, Chapter 14" document: "M-21-1" section: "Part V, Subpart iii, Chapter 14" canonical: "https://veteranai.co/va-regulations/m21-1/v.iii.14" source: "https://www.knowva.ebenefits.va.gov/system/templates/selfservice/va_ssnew/help/customer/locale/en-US/portal/554400000001018/content/554400000180509/M21-1-Part-V-Subpart-iii-Chapter-14-Dental-and-Oral-Conditions" updated: "2026-09-07T14:37:19.314128Z" --- October 10, 2019 ### V.iii.14.1.a. Interpreting Claims Raising Dental Issues Service connection (SC) for dental/oral disabilities and conditions can be established for * compensation purposes, or * treatment purposes _only_. Generally assume that a claim for a dental/oral disability or condition, filed on a prescribed form, seeks SC for _compensation_ purposes unless the claim’s wording clearly communicates pursuit of dental treatment, in which case, follow procedures found in [M21-1, Part XIII, Subpart i, 4.B.1.a](). **Important:** * Under [38 CFR 3.381(a)](), the Veterans Benefits Administration will adjudicate a claim for SC of a dental condition for _treatment_ purposes **_after_** the Veterans Health Administration (VHA) determines a Veteran meets the basic eligibility requirements of [38 CFR 17.161](). Therefore, do **_not_** address as an actionable contention, or in the setting of a rating decision, the issue of SC for treatment purposes unless prompted to do so by a specific request from VHA. * The rating principles discussed in this section are specific to determinations of SC **_for compensation purposes_**. Rating for dental treatment purposes, conversely, is discussed in [M21-1, Part XIII, Subpart i, 4.C](). **References:** For more information on * processing dental treatment requests, see [M21-1, Part XIII, Subpart i, 4.B](), and * clarifying claims, see [M21-1, Part III, Subpart i, 2.D.1.c](). ### V.iii.14.1.b. General Information on SC for Dental and Oral Disabilities for Compensation Purposes Claims for SC of **_dental and oral disabilities_** are developed and decided pursuant to the same policies and procedures that apply to SC for compensation purposes of conditions of other body systems. When notifying a Veteran of a decision to grant compensation-purpose SC for a dental or oral disability, include language to the following effect in the rating decision narrative: _Although your dental condition or disability is service-connected, eligibility for treatment for that disability is limited by statute. You may not be eligible for VA dental care. _ _Please contact the VHA facility that is nearest your home for a determination on whether you are eligible for treatment for your service-connected dental condition or disability._**Reference:** For more information on interpreting claims raising dental issues and the definition of a dental disability, see M21-1, Part V, Subpart iii, 14.1.a. ### V.iii.14.1.c. Dental/Oral Contentions for Which Compensation-Purpose SC May Not Be Established Generally, and unless otherwise contraindicated, any dental/oral condition that may be rated under, or by appropriate analogy to, the diagnostic code (DC) criteria of [38 CFR 4.150]() is potentially subject to SC for compensation purposes. However, the following are prohibited from being deemed service-connected (SC) for compensation purposes: * treatable carious teeth * replaceable missing teeth * dental or alveolar abscesses * periodontal disease * dental calculi * third molars * impacted or malposed teeth (and other similar developmental defects), and * teeth extracted because of chronic periodontal disease. **Note:** [38 CFR 4.150, DC 9913](), _does_ permit and provide for potential compensation-purpose SC for missing teeth; however, it also requires that such tooth loss be associated with underlying bone (maxilla/mandible) loss acquired as a result of * service trauma, as discussed in [M21-1, Part XIII, Subpart i, 4.C.1](), or * non-periodontal disease, such as osteomyelitis. **References:** For more information on conditions that may be considered SC for * treatment purposes _only_ , see [M21-1, Part XIII, Subpart i, 4.C.1](), and * _neither_ compensation nor treatment purposes, see [M21-1, Part XIII, Subpart i, 4.C.1](). ### V.iii.14.1.d. Dental Examinations in Compensation Claims for a Dental Disability Obtain a dental examination for purposes of SC or evaluation purposes when necessary. Dental examinations are considered specialist examinations. **References:** For more information on * when an examination is necessary under the duty to assist for a dental or other disability, see [M21-1, Part IV, Subpart i, 1.A]() and [B](), and * specialist examinations, see * [M21-1, Part IV, Subpart i, 2.A.1.g](), and * [M21-1, Part IV, Subpart i, 2.A.6](). ### V.iii.14.1.e. Denying Dental Claims for SC Compensation Consider the issue of SC for compensation purposes for the conditions listed in [38 CFR 3.381(b)]() in a formal rating and deny the claim if * a Veteran claims compensation for one of these conditions, and * the record shows no complicating condition that is subject to SC. In the _Narrative_ of the rating decision, discuss that under [38 CFR 3.381(b)]() SC for such conditions can be established only for treatment purposes, and note if dental treatment in service was limited to conditions affecting only the teeth or gums. ### V.iii.14.1.f. Schedule of Ratings for Dental and Oral Conditions The schedule of ratings for dental and oral conditions are contained at [38 CFR 4.150](). **Important:** When there is competent and credible medical evidence of impairment associated with conditions listed in [38 CFR 4.150]() DCs that cannot be evaluated within the listed diagnostic criteria, that impairment must be evaluated separately. Examples of potentially-associated impairments include (but are not limited to) * loss of * vocal articulation * smell, or * taste * neurological impairment * respiratory dysfunction, or * other impairments (such as scars). **Important:** The guidance on other impairment associated with dental and oral conditions was added as Note (2) to changes to [38 CFR 4.150]() effective September 10, 2017. However, as currently provided in [M21-1, Part V, Subpart ii, 3.A.2.c](), when deciding expressly claimed issues, decision makers must consider entitlement to any complications that are within the scope of the claim including those identified by the rating criteria. **Reference:** For more information on the dental-oral rating schedule changes, see M21-1, Part V, Subpart iii, 14.1.g. ### V.iii.14.1.g. Dental-Oral Rating Schedule Changes A final rule made amendments to the rating schedule provisions for dental and oral conditions ([38 CFR 4.150]()) effective September 10, 2017. The changes were _**not**_ considered liberalizing. **Reference:** For more information on handing claims when there are regulatory changes, see [M21-1, Part V, Subpart ii, 4.A](). ## 2. Rating Specific Dental and Oral Conditions This topic contains information on rating specific dental and oral conditions, including * diagnostic imaging confirmation requirement for evaluations based on nonunion of the mandible or maxilla * special considerations in evaluations for temporomandibular disorder (TMD), and * definition and evaluation guidelines for bruxism. May 27, 2020 ### V.iii.14.2.a. Diagnostic Imaging Confirmation Requirement for Evaluations Based on Nonunion of the Mandible or Maxilla Under [38 CFR 4.150, DC 9903](), nonunion of the mandible requires confirmation by diagnostic imaging studies. Under [38 CFR 4.150, DC 9916](), maxillary nonunion requires confirmation by diagnostic imaging studies. As defined in the note to [38 CFR 4.150](), **_diagnostic imaging studies_** include _but are not limited to_ * conventional radiography (x-ray) * computed tomography (CT) * magnetic resonance imaging (MRI) * positron emission tomography (PET) * radionuclide bone scanning, and * ultrasonography. The term **_nonunion_** refers to incomplete healing after an adequate healing period with fibrous union and mobility of fracture segments. **Important:** An actual copy of the imaging study does not need to be present in the claims folder. However, the folder must reflect confirmation that the imaging was reviewed by the examiner. **Note:** Although this is a new regulatory requirement, added to [38 CFR 4.150]() effective September 10, 2017, the September 2016 version of the [_Oral and Dental Conditions Including Mouth, Lips And Tongue (Other Than Temporomandibular Joint Conditions) Disability Benefits Questionnaire_]() asks if x-rays or other studies, to include studies of the maxilla and mandible, have been conducted and instructs the examiner that if studies supporting the diagnosis are already of record they do not have to be repeated. For cases pending on the effective date of the change of law, September 10, 2017, if there is a diagnosis of nonunion unsupported by diagnostic studies, obtain clarification. ### V.iii.14.2.b. Special Considerations in Evaluations for TMD Temporomandibular disorder (TMD) (which may also be called temporomandibular joint dysfunction (“TMJD” or more colloquially TMJ”)) is evaluated under [38 CFR 4.150, DC 9905](). Evaluation levels are based on * limitation of inter-incisal range of motion (with or without dietary restrictions), or * range of lateral excursion. When assigning an evaluation there are a number of considerations. For Department of Veterans Affairs purposes, normal maximum unassisted range of inter-incisal motion is 35 to 50mm. * A 10-percent evaluation can be assigned for no more than 34 mm of inter-incisal motion. * Under the prior version of the DC (effective prior to September 10, 2017), a 10-percent evaluation was available for motion up to 40 mm. For each range of maximum assisted inter-incisal motion, the appropriate evaluation to assign will depend on whether or not the condition necessitates dietary restriction to mechanically-altered foods. * The regulation provides in Note (3) that **_mechanically altered foods_** are foods altered by blending, chopping, grinding, or mashing to make them easier to chew and swallow. Mechanical alteration can be to one of four levels or gradations: full liquid, puree, soft, and semi-solid. * The note refers to dietary restrictions in which mechanically altered foods are required as **_texture modified diets_**. * Dietary restrictions involving any textured modified diet (any grade of mechanically altered food) must be recorded or verified by a physician. * A contention or testimony by an individual that he or she is using a texture modified diet or requires one due to the SC condition is not sufficient to establish that the condition necessitates a texture modified diet with restriction to mechanically altered foods. * Endorsement of the need for the dietary restriction to mechanically altered foods by a competent medical professional is required. An examination report may satisfactorily record or verify that the SC condition necessitates the dietary restriction to mechanically altered food. With respect to inter-incisal range of motion, the DC requires ranges be “unassisted.” This means active range of motion. In assigning an evaluation for TMD or any other dental disability on the basis of limited motion of temporomandibular articulation under [38 CFR 4.150, DC 9905](), **_do not_** assign separate evaluations for limited inter-incisal motion or painful motion involving each side of the jaw. Doing so is pyramiding. Only **_one_** evaluation may be assigned. If both sides of the jaw are affected, use the limitation of motion on the side that affords the highest evaluation. **Example:** Maximum unassisted inter-incisal motion is limited to 34 mm on the right and 25 mm on the left. There is no dietary restriction to mechanically altered foods. There is credible evidence of actually painful motion of both sides of the jaw. Assign a single 20-percent evaluation under [38 CFR 4.150, DC 9905](). **_Do not_** assign separate 10-and 20-percent evaluations.Do not combine ratings for limited inter-incisal motion with a rating based on limitation of lateral excursion of the jaw. **References:** For more information on * entitlement to a single rating for limitation of inter-incisal motion to include as due to painful motion, see [_Vilfranc v. McDonald_](), 28 Vet.App. 357 (2017) * painful motion for joint conditions under [38 CFR 4.59](), see [M21-1, Part V, Subpart iii, 1.A.1]() * choice of law for cases pending at the time of a regulatory change, see [M21-1, Part V, Subpart ii, 4.A.6](), and * the prohibition against pyramiding, see * [38 CFR 4.14](), and * [M21-1, Part V, Subpart ii, 3.D.2.b](). ### V.iii.14.2.c. Definition and Evaluation Guidelines for Bruxism ** _Bruxism_** is defined as excessive grinding of the teeth and/or excessive clenching of the jaw. It may not be evaluated as a stand-alone SC disability.